Excerpts from Must Read Books & Articles on Mental Health Topics
Books, Part II


Is There No Place on Earth for Me?- Susan Sheehan
Chapter 13, pp. 203-215

    When Thorazine, Stelazine, Mellaril, Compazine, and Trilafon -- all of them members of a group of drugs called the phenothiazines-- were first used in the United States, in the 1950s, they were called tranquilizers. Later, as Miltown and, still later, Librium and Valium came to be widely employed and generally referred to as tranquilizers, psychiatrists began to distinguish between these two distinctive groups of drugs by calling the former major tranquilizers and the latter minor tranquilizers. They soon regretted this nomenclature by comparison, because it gave the false impression that these drugs were of the same type, with one group simply stronger than the other. The minor tranquilizers are completely ineffective in treating the symptoms of psychosis, and are all potentially addictive. What the minor tranquilizers have in common with the major tranquilizers is that both have anti-anxiety effects; the minor tranquilizers are now more accurately called anti-anxiety drugs. The major tranquilizers -- which are not addictive -- were eventually renamed antipsychotic drugs, not only in an attempt to differentiate them from the minor tranquilizers but also to clear up a common misconception that they worked by making people groggy and easily manageable. Unlike the barbiturates that were used in mental hospitals for decades, these drugs don't work by putting people to sleep or dulling their senses. They work by reducing the hallucinations, the delusions, and the thinking disorders characteristic of the psychotic phase of schizophrenia and other psychoses, without putting psychotic patients to sleep. More recently, many psychopharmacologists have preferred to call these drugs neuroleptics, for they are all capable of producing certain neurological side effects. In addition, some neuroleptics were found to be useful in other branches of medicine. Compazine, for example, is useful for treating nausea and vomiting, and a parent is more likely to give it to a normal child if it is called a neuroleptic than if it is called an antipsychotic. Twenty neuroleptics are currently in use in the United States; many others are used in other parts of the world.
    For some years after Thorazine and the other neuroleptics were introduced, it was not known how they worked. In the last few years, psychopharmacologists have achieved a better understanding of this. There are hundreds of billions of cells in the brain called neurons, which interconnect. The connecting points between neurons are called synapses. At most synapses, a chemical known as a neurotransmitter is released at the end of one neuron, travels a minute distance to the next neuron, and influences that neuron to transmit the impulse. About a score of different neurotransmitters are known today, and a large number are probably yet to be discovered. The neurotransmitter that has been most implicated in schizophrenia is dopamine. During the psychotic phase of schizophrenia, there seems to be an excess of dopamine transmission in the neurons in specific areas of the brain. All the neuroleptics are known to block the dopamine receptors so that the dopamine released at the end of one neuron cannot get to the receptor site of the next neuron.
    More than ninety percent of all schizophrenic patients undergoing their first psychotic episode will respond to any one of the twenty neuroleptics if the proper dose is given for the proper length of time. One neuroleptic is thus normally no more effective than another in ridding a patient of delusions, despite claims of drug companies to the contrary. The drugs do, however, have different side effects. The reason that a knowledgeable doctor usually prescribes one neuroleptic rather than another for a patient with no prior history of treatment is that he is familiar with a drug or knows that it has a particular spectrum of side effects. Thorazine is one of the neuroleptics that have a strong sedative side effect. A number of specialists in psychopharmacology have gone so far as to call it "obsolete" and have ceased to use it clinically, because it has numerous undesirable side effects, including the over-sedation. The sedative property is the characteristic that makes it especially popular in understaffed state hospitals, where attendants find heavily sedated patients easier to control. Thorazine is one of the most commonly prescribed drugs at Creedmoor.
    In the mid-sixties, Thorazine and Stelazine, which are manufactured by the same drug company, were often given simultaneously, as they were to Sylvia Frumkin at Gracie Square and at St. Vincent's in 1964. The theory behind giving patients both Thorazine and Stelazine was that the patients would get the combined therapeutic effects of both drugs, and that the side effects would be fewer or would cancel each other out. This combination of two neuroleptics was approved by the Food and Drug Administration on the basis of inadequate scientific evidence. Subsequent evidence showed clearly that there was rarely any advantage in prescribing Thorazine and Stelazine simultaneously, but that here was a disadvantage, because patients got the full side effects of both drugs: sedation, dryness of mouth, lowering f blood pressure, and tremors. Another unfortunate consequence of the FDA's approval of this combination (which any psychiatrists still prescribe frequently) is that it gave the agency's blessing to polypharmacy - the administering of simultaneous doses of two, three, four, or more neuroleptics. For the schizophrenic patients on whom a particular neuroleptic is ineffective, a knowledgeable psychiatrist will switch from that neuroleptic to another that has a different molecular structure. To facilitate the switching, most psychiatrists have access to an equivalency table. Equivalency tables are based on 100 milligrams of Thorazine and show the amount of one drug that is approximately equal to the amount of another. For example, Mellaril and Serentil are two neuroleptics of low-milligram potency, like Thorazine: A hundred milligrams of Mellaril is the equivalent of 100 milligrams of Thorazine, and 50 milligrams of Serentil is the equivalent of 100 milligrams of Thorazine. Most neuroleptics are high-milligram-potency drugs; thus, 10 milligrams of Trilafon or Moban is the equivalent of 100 milligrams of Thorazine.
    The resident at St. Vincent's who prematurely lowered Miss Frumkin's dose of Thorazine was committing an error that illustrates the difficulty of prescribing neuroleptics. In many fields of medicine, it is relatively easy to prescribe drugs, because there are standard doses for whole classes of ailments, and these can be memorized. For the infectious diseases that are responsive to the tetracycline antibiotics, for instance, the adult dosage is usually 250 milligrams four times a day; in some cases, the dose is twice that. There are no standard doses in psychiatry. For one patient, 200 milligrams of Thorazine may be sufficient to clear up the delusions over a period of time; another may require 2000 milligrams to achieve the same result. Studies have been done which demonstrate that if you give a group of patients a standard dose of a certain tricyclic antidepressant (a chemical class of antidepressants characterized by a three-ringed molecular structure), and then, after a sufficient period of time, measure the level of the drug in the blood, one individual may have as much as a hundred times the amount that another has. Other less dramatic but still significant differences are quite common. The drug levels in the blood of identical twins are almost identical; those of close relatives show a high correlation; those of strangers show no correction. Currently, it is routine to measure blood levels of lithium, and in the past several years it has become possible to measure the blood levels of tricyclic antidepressants in clinical psychiatric practice, as distinct from a research setting. These measurements can provide psychiatrists with a better guide to prescribing adequate doses of such drugs. Only recently has it become possible to measure the blood levels of neuroleptics, but the clinical value of these measurements has not yet been conclusively determined. For the seventeen years that Sylvia Frumkin has been on neuroleptics, therefore, psychiatrists have been prescribing drugs for her simply on the basis of her observed responses. Many fifteen-year-olds suffering their first psychotic breaks respond to 500 milligrams of Thorazine within ten days. Sylia Frumkin's failure to respond quickly or favorably to much higher doses of Thorazine indicated a poorer prognosis for treatment.
    In 1964, voluntary hospitals like St. Vincent's wanted "good" patients, not troublesome ones. Shortly after Sylvia Frumkin swallowed shampoo, her parents were told that because she had "regressed to her pre-admission state of disorganization," St. Vincent's would be able to do nothing further to help her during the ten or twelve days that remained before the ninety day period covered by Irving Frumkin's insurance expired. The resident said that Sylvia would need long-term hospital care. For everyone but a few of the very rich who are able both to afford private hospitals and to find the private hospitals willing to accept difficult cases, this means going to a state hospital. In 1964 (as in 1981), the state hospital that served the residents of Queens was Creedmoor. Patients at Creedmoor were billed seven dollars a day in 1964. When Sylvia Frumkin was discharged, the St. Vincent's resident diagnosed her illness as acute schizophrenia, undifferentiated, unimproved.
    In 1964, the only way a patient in a hospital like St. Vincent's could be admitted to a state hospital was by way of a city hospital, such as Bellevue. On June 11, 1964, therefore, Sylvia was taken by ambulance from St. Vincent's to Bellevue. Mrs. Frumkin, Joyce, and an attendant from St. Vincent's accompanied her on the short ride. Sylvia was fairly calm in the ambulance, although she was troubled by the idea of being transferred to yet another hospital. "Is there no place on earth for me?" she asked her mother in a plaintive voice. It was a question that Sylvia asked her mother dozens of times over the next seventeen years. Her admission to Bellevue was merely a paper admission, but it took a while. Sylvia became wilder as time dragged on. After three hours, she was admitted to an ambulance bound for Creedmoor instead of to a ward at Bellevue. In the ambulance there were several other patients and a policeman. With its back window protected by wire mesh, and with long, hard benches inside, the ambulance resembled a paddy wagon. Joyce and Mrs. Frumkin followed the ambulance out to Creedmoor in Joyce's car.
    As soon as Mrs. Frumkin saw Building 40, Creedmoor's seventeen-story skyscraper, from the Grand Central Parkway, she thought back sadly to 1962, when she and her husband had felt so proud of their daughters, with Joyce having just announced her engagement and with Sylvia about to start at Music and Art. Mrs. Frumkin had heard of Creedmoor in 1962, but she had never seen the hospital, let alone imagined that one of her daughters would wind up there. "Creedmoor" was then just a word that a friend might use in a sentence like "He's so crazy he should be in Creedmoor." By the time Mrs. Frumkin and Joyce reached Creedmoor, where Mr. Frumkin met them, they were emotionally drained. Sylvia was in a rage. Building 40, which had opened in 1960, was then Creedmoor's newest building. It served as the hospital's medical building and contained its admissions wards. Patients who improved quickly were discharged from Building 40. Those who didn't were dispatched, after a period of twelve to eighteen months, to the "back wards," which were located in a large number of three and four story buildings that were spread out on Creedmoor's three hundred-acre site.
    Sylvia Frumkin was admitted to Creedmoor by Dr. Ida Feller, a psychiatrist on the women's reception staff. Sylvia was very upset that her father had to sign the forms required to admit her on a voluntary application for a minor, and claimed that she was "a grown-up lady." The Frumkins gave Dr. Feller, a European-born woman in her fifties, a synopsis of the recent events in Sylvia's life: her schooling, her therapy at the Jamaica Center, her car accident, her fifteen days at Gracie Square, and her eighty-two days at St. Vincent's, including her attempt to drink a bottle of shampoo. Sylvia told Dr. Feller that "Sylvia died in the accident." She also said that she invented new names for herself and imagined she was somebody else. She told the psychiatrist she had run away to her aunt and uncle and wanted them to adopt her, because she couldn't get along with her parents. Dr. Feller's diagnosis was schizophrenia, undifferentiated type. Sylvia was put in Ward 10-A, the women's new admissions ward, and was started on a daily dose of 300 milligrams of Thorazine -an even smaller dose than the one that had been insufficient to alleviate her symptoms at St. Vincent's.
    On June 26, four days after her arrival, a doctor assigned to 10-A interviewed Sylvia Frumkin and wrote up a mental status report. His principal findings were that she was very agitated, that her thoughts were dissociated, and that she expressed suicidal intention, paranoid ideation, and delusions of persecution. Her affect was "flat," her mood was hostile, and her insight and judgment were impaired. In his report, the doctor included a sample of the dialogue he had exchanged with her:
    I want to go to Freedomland with Paul Anka. (Do you know him?) No, but he knows me. I've lost the feeling that I'm Diana the Goddess. I have to face reality. Maybe I'm not Diana. I don't know. (Hear voices?) I talk to Paul. I hear his voice all the time. (People against you?) Yes - No I don't know. (Feel like committing suicide?) Yes, plenty of times. (Have you tried?) Yes. All kinds of things, razor blades, cigarettes. (Anything else?) I don't remember. I don't want to be normal. Are you going to tear down everything? I want to be Diana -- I'm not sick. I want to be Diana. That's all I want to be. I had a crackup three months ago. I don't really consider myself sick, though. I want to run in the wind. No, not really.
    Although the attendants in Ward 10-A wrote in their progress notes that Miss Frumkin was restless, nervous, and confused, her daily dose of Thorazine was lowered to 200 milligrams on July 16. The specialist in psychopharmacology who recently reviewed her record said that lowering the dose instead of raising it could be described only as "irrational and incompetent." Three or four hundred milligrams of Thorazine might have been a reasonable starting dose, but when it was ineffective the only sensible thing to do was to raise the dose. He pointed out that in the mid-sixties Creedmoor was noted for under-medicating its patients.
    Although Ward 10-A at Creedmoor was not as attractive as Gracie Square or St. Vincent's, it was one of the most pleasant wards at Creedmoor in 1964. It contained the new, and thus usually the most promising, patients, some of the hospital's most modern furniture, and a high ratio of staff to patients. When Sylvia Frumkin became unruly in mid-July and mid-August--she snatched food from other patients, fought with them, refused to wear shoes, and ran up and down the hallway -- she was sent from Ward 10-A to Ward 11-A, one of Building 40's "overactive" wards, for aggressive and assaultive women patients. It was then, Mrs. Frumkin remembers, that the real horror of Sylvia's hospitalization hit her. Many of the patients in 11-A were kept in straitjackets, the ward was noisy, and there were few organized activities. On August 12, Sylvia was taking 200 milligrams a day of Thorazine and 4 milligrams a day of Stelazine - the equivalent altogether of 280 milligrams of Thorazine. That day, a psychiatrist wrote on her chart, "Patient did not show much improvement on drug therapy . . . and, therefore, she will start a series of ECT today."
    Electroconvulsive therapy, or ECT, commonly called electroshock, had been introduced in New York State psychiatric hospitals in the early 1940s. Before the advent of Thorazine in 1954, the frequency with which ECT was given increased each year. After Thorazine, the use of ECT declined precipitously. In 1964, Sylvia Frumkin was among the one percent of the patients at Creedmoor who received ECT. Between August 12 and September 4, Miss Frumkin was given eleven shock treatments-one every two or three days. After the first two treatments, attendants noted an improvement in her condition; they described her in their notes as "pleasant, talkative, cooperative." On August 23, after five treatments, she was given grounds privileges. After she had completed eleven treatments, she was able to make weekend visits to her parents' home or to Joyce's apartment. The Frumkins described Sylvia's improvement on ECT as "nothing short of a miracle." Sylvia has only vague memories -- none of them painful or traumatic --of the ECT treatments she received at Creedmoor in 1964 and of subsequent ECT treatments she received at Creedmoor and at several other hospitals. The specialist in psychopharmacology who reviewed her record was not impressed by the "miracle" of ECT. "We know in 1981 and we knew in 1964 that ECT is not the treatment of choice for schizophrenic patients with her symptoms," he said. "I think she should have been given adequate medication. There are two possible explanations for her sudden improvement in 1964. Most likely, the ECT worked. It occasionally does work the first few times it's used on some schizophrenics, despite being generally inappropriate. ECT is still the preferred method of treatment for some severe forms of depression and catatonic schizophrenia. There's also the possibility that, coincidentally, her first acute episode of schizophrenia was already coming to an end. Schizophrenia is often an episodic illness. Even in the old days, when hospitals had no drugs and no shock therapy, it often took several episodes of schizophrenia before the patient who returned to the state hospital never got out again."
    In September of 1964, plans were being made for Sylvia's discharge from Creedmoor. The Frumkins had sued the young man who hit their daughter with his car on January 27 and the young man's father, the owner of the car. Because the lawsuit was pending that fall, Sylvia's case was presented as "a case of interest" at a general staff meeting -a weekly gathering of administrators, doctors, and residents --on September 25. By then, Mrs. Frumkin was attributing Sylvia's illness to the car accident, and she continued to do so for the next seventeen years. "When she opened her eyes after she was hit, they were never the same," Mrs. Frumkin says.
    The psychiatric profession has never agreed on the causes of schizophrenia or other mental illnesses. The disagreement is sometimes referred to, with alliterative simplicity, as "nature versus nurture." The controversy is more complicated than that. It arises out of the conflict between the Platonic concept that the mind and the body are separate and independent entities -- a concept that was unchallenged in Western thought until relatively recently -- and the concept, derived from modern science, that the mind and the body are one, the mind being just a manifestation of the workings of the brain. The side of the controversy that Francine Baden represents -- the so-called nurture school -- harks back to the Platonic concept. The theory of this school of psychiatrists and psychologists is that mental illness is wholly a troubling of the mind caused by a poor environment -- that is, poor human relationships, which invariably date back to childhood. While Miss Baden did not use the term schizophrenogenic mother -- schizophrenia-causing mother -- she singled out the figure most often blamed by this school for child's improper nurture: the mother. "It is felt that the case problem is the symbiotic tie with her mother," Miss Baden had written in her summary report on Sylvia Frumkin. She had concluded her statement by proposing the treatment method advocated by this school -- psychotherapy. The theory holds that since the illness is caused by faulty human relationships, it can be successfully treated by appropriate psychological intervention to change the relationships and the patient's pattern of behavior and thought.
    The opposing side in the controversy, the so-called nature school, consists of biologically oriented psychiatrists, who have followed to its logical conclusion the concept of the mind developed by modern science. Their theory holds that mental illness is a physiological or biochemical imbalance in he body that is affecting the brain, and should be treated with physical remedies. Ironically, Sigmund Freud lent some support to the thinking of this school. He believed that psychoanalysis could do little for schizophrenics and other psychotics, as opposed to neurotics, and that drugs might have a significant impact on psychiatry. "The future may teach us how to exercise a direct influence by particular chemical substances," he predicted. Early adherents of this school pointed to two physical ailments accompanied by psychotic symptoms - pellagra, a vitamin-deficiency disease, which is treated by administering niacinamide to the patient in order to supply him with niacin; and general paresis, a late stage of syphilis that affects the brain and was treated originally with arsenicals and subsequently with penicillin - as evidence that their theory was tenable. These biologically oriented psychiatrists were the practitioners who prescribed sedative packs and continuous-flow tubs in the 1920s, insulin-coma therapy and electroshock therapy in the 1930s and 1940s, and, starting in the 1950s, the antipsychotic drugs. They had also long suspected that heredity was a factor in mental illness. By the early 1970s, enough research had been done to strongly suggest that -- at least for a number of serious mental illnesses, including schizophrenia -- the biologically oriented psychiatrists were right about both chemical imbalances and genetic factors.
    Eugen Bleuler, a Swiss psychiatrist, whose book Dementia Praecox; or, The Group of Schizophrenias was published in 1911, coined the word schizophrenia, but used it in the plural. The third, and latest, edition of the American Psychiatric Association's Diagnostic and Statistical Manual of .Mental Disorders, which was published in 1980, uses schizophrenia in the singular but says in a footnote that it is to be considered in the plural. The most enlightened current thinking is that schizophrenia is a variety of illnesses, many of which clearly have a genetic factor that has not yet been entirely documented. (There may also be some rare forms of schizophrenia that have other causes.) In this century, the incidence of schizophrenia in all societies where statistics have been kept and analyzed -- in the United States and in countries in Africa, Asia, and Europe -- is in the neighborhood of one percent. Studies show that the likelihood that a child with one schizophrenic parent will be schizophrenic is ten percent. If both parents are schizophrenics, the odds are at least thirty percent. The genetics of schizophrenia do not appear to be simple. According to one widely held genetic theory, the genetic disposition can be so powerful that the individual will manifest schizophrenic symptoms no matter how benevolent the environment in which he or she is raised. The environmental factor becomes more important when the individual inherits a moderate or low predisposition to schizophrenia. If the environment is a good one, there is a fair chance that a person with a moderate predisposition to schizophrenia will not manifest its symptoms. If there is a low genetic predisposition to schizophrenia and the environment is good, the chances are even less. An individual with a low disposition to schizophrenia who went into the army might be able to go through basic training and combat two forms of high stress -- without manifesting schizophrenia, but if he should be taken prisoner and subjected to harsh conditions, such as brainwashing, these conditions might trigger the illness. A person who is without genes for schizophrenia might emerge from a POW camp with severe neurotic, psychosomatic, or depressive symptoms, but no amount of stress could make him a schizophrenic.
    When Sylvia Frumkin was hospitalized at Gracie Square in 1964, her parents were asked if there had been any mental illness in the family. They replied that there hadn't. The doctor taking the record wrote, "Family history reveals no neuropsychiatric disease." Like many families in a similar situation, the Frumkins had not been candid with the doctor. Irving Frumkin's brother, Julius, had to be put in a psychiatric hospital twice during his late teens. Afterward, he was unable to go to college as the family had hoped he would. He was able to hold a series of menial jobs, the longest-lasting of them as a deliveryman for a florist. He always lived at home -- with both parents until his father's death, in 1954; with his mother until her death, in 1972; and then alone, in the same apartment, until his own death, in 1977. Sylvia and Joyce Frumkin remember that when they visited their paternal grandparents, Uncle Julius never spoke to them. One day, Sylvia asked him a question about a book he was reading. He walked out of the room and slammed the door in her face. Irving Frumkin does not like to admit that there was anything irregular about his family, but when he is pressed to do so he will acknowledge that his brother Julius was a schizophrenic. It was not until 1979 that his wife learned that his parents had been first cousins; for over forty years, he had allowed her to assume that they were third or fourth cousins. When psychiatrists have asked Harriet Frumkin if there was any mental illness on her side of the family, she has never told them that her Aunt Vera spent the last years of her life in Pilgrim State Hospital. As well as can be determined, Sylvia Frumkin probably inherited at least a moderate genetic predisposition to schizophrenia, and her childhood environment was sufficiently stressful to trigger the illness. In early 1963, when she was fourteen --roughly a year before the automobile accident and her hospitalization at Gracie Square -- a psychiatric social worker, a psychologist, and a psychiatrist at the Jamaica Center for Psychotherapy had successively diagnosed her as a schizophrenic.
    After the psychiatrists who considered Sylvia Frumkin's case at the general staff meeting at Creedmoor on September 2-5, 1964 interviewed her about her psychiatric history, it was their unanimous opinion that her mental illness had begun before the car accident. Unfortunately for the Frumkins, the lawyers for the driver's insurance company subpoenaed the records. The Frumkins were subsequently able to obtain from the director of Creedmoor a statement that "Miss Frumkin's mental status may have been aggravated by the accident in which she was involved," and they were able to get two psychiatrists to testify in court to the same effect. In the spring of 1971, the case was finally settled, for twenty thousand dollars. Shortly after the general staff meeting, Sylvia Frumkin was recommended for discharge. She was advised to take a hundred milligrams of Thorazine daily after her discharge, as a maintenance dosage, and to seek private psychiatric care.


Terry: My Daughter's Life-and-Death Struggle with Alcoholism- George McGovern
Chapter Six- "Three things I need today: conversation, to be told I'm pretty, to have my pain validated."

    Terry's life after the summer of 1988 was so chaotic--such mixture of hope and despair, love and resentment, sobriety and relapses--that it is bewildering to piece the story together. It is difficult to tell a coherent story about an incoherent life. The story is further complicated by Terry's increasing confusion and her contradictory accounts of what was going on in her life as alcoholism befogged her brain and tortured her spirit.
    Alcoholics and their advisers frequently speak of "hitting bottom"--meaning that the disease progresses to such depths that the victim can sink no lower and still survive. This stark reality sometimes leads the alcoholic into a desperate commitment to recovery. But it more likely leads to further disasters and an untimely death. Terry seems to have hit bottom several times after 1988, but she did not give up the struggle for recovery. Nor did she succeed in achieving it in any real sense. What both amazes me and breaks my heart is the incredible grit, grace, and humor that she maintained in the closing years as she battled the stalking killer that would give her no peace and no mercy.
    In the midst of my search for both the order of events and the content of these turbulent final years, I discovered a personal document written by Terry in 1992--a candid account of events and relapses in recent years. It may have been simply an effort to clear her own mind by sorting out the tangled pieces of her life. Or as I have suspected from many of her journal entries, it may also have been the work of a person with a sense of history who wanted to include some of the hidden aspects of her troubled life. It is not a pleasant story.
   Summer '88 -Went to Arizona with Ray and our girls to visit Ray's family. Argued with Ray's mother-I left Arizona early with girls drunk on plane--several times before Ray returned had to have Jim take care of Marian and Colleen. Got sober.
    Oct. '88- Ray left for good
    1988- Got job at [Wisconsin state treasurer] Charles Smith's office
    March '89- Colleen's birthday--still sober
    May '89-Marian'S 4th birthday-pool outside--still sober
    June '89-My 40th birthday party with Joe, Susan, Ernie, Marian, and Colleen--took Ativan [a tranquilizer] eventually I started smoking pot--drinking? crying with Joe-he left scared.
    1989-Katy's-smoking pot--imipramine [an antidepressant], very scary, high anxiety. Would get Marian to Woodland school late, got stoned and hang out, not aware of tension it was causing.
    1989--on AFDC, food stamps, child support. Late summer--kicked Ray's apt. door in. He bad me arrested and jailed. Mom came night Of arrest. Went into treatment within a week or two in Milwaukee, Oct. 1989.

   For the last weeks in 1989 and most of 1990, she worked hard in the Milwaukee treatment program, which combined the AA recovery formula with psychological counseling. After five months, she rented a pleasant apartment in Milwaukee, got a clerical job, and continued an outpatient recovery program for the next nine months. During her inpatient care, she was given a pass on weekends to see her children in Madison. After she gave up the Madison duplex and acquired an apartment in Milwaukee, Ray would drive the children halfway to Milwaukee, and Terry would meet them with an old Chevrolet I had given her and drive them the rest of the way to her apartment for the weekend. It was not the most convenient arrangement, but the weekends were generally happy times-and Terry was sober from October 1989 until the end of 1990.
    I did enjoy it and my children enjoyed it. I went to regular meetings, called my sponsor, but I did limit intimacy, social times.
    December 1 990- moved back to Madison--I drove to D.C. for Xmas with Marian and Colleen-very proud of myself as to how well I planned it. And that I conquered fear of driving that distance alone-- never driven more than 5 hrs. alone. Also proud that I wasn't asking for money for plane tickets. Was very hurt when my sister called to apologize for talking behind my back with Susan about their resentment towards me for Dad helping me out financially.
    I drank a few days later--the night before Christmas. No one ever knew because I stopped it right away. Drive back to Madison after Christmas holidays. Started drinking about two hours away from Madison--was pretty drunk when I got to town, snowing, drove off elevated driveway. Got drunker, screamed at Marian and Colleen out of my own fear about drinking, they were sitting on the couch, both crying. I told them Grandpa George would be coming in the morning and make everything O.K. I wanted them to feel safe. I felt very unsafe.
    I did get job at Madison General Hospital, but too much stress--I had girls 4 evenings a week--get them to school and get to my job.... didn't like my sponsor, my landlord or other tenants or apartment-never really unpacked.... started drinking at work, quit with nothing else lined up. Drinking getting out of control. Did get sober for close to 2 months, but unhappy, seemed like things didn't get better.... Drunk for Colleen's 4th birthday party. Passed out halfway through, threw up on the bedroom floor.... I didn't want to cut back on my time with girls--didn't want to admit to Ray I couldn't handle it. [Ray had the girls on the weekends.]
    Eventually, my drinking out of control and I had no more outside responsibility--no job, no children, no AA contact. Was staying drunk for days at a time, only leaving apartment to get more alcohol. [Ray assumed custody and care of the children.] Wouldn't know what day it was or bow long I'd been blacked out or passed out. Nighttime would be a nightmare". So much fear. And no more alcohol. Couldn't pay rent anymore and couldn't get it together to find another living situation.
    DWI and jail on way back from Milwaukee. Made attempts to get sober. Looked into halfway house--women and children center-not enough support to pull anything off.
    Went to my friend Joan's--used her plenty but no other choice--lived there about a month started drinking her booze ... another DWI while in liquor store parking lot. Ended up in St. Mary's for alcohol poisoning, kept leaving to get alcohol, decision made to put me in locked psyche unit.
    July '91- went to D.C., stayed sober until November.

   Eleanor and I were alarmed and discouraged by Terry's repeated relapses--even after the prolonged and apparently excellent recovery program in Milwaukee. Partly in the hope that one more effort in the security of our Washington home might yet open the way to her recovery, we urged her to move in with us, which she did for the last half of 1991.
    At our invitation, Marian and Colleen came to be with her for ten days in October. Terry began drinking several weeks after they left. She was so out of control that to protect her from self destruction, we had her involuntarily committed to St. Elizabeth's Hospital in Washington. Only the threat of intervention by a police team enabled us to get her into the hospital. After she was detoxed and stabilized there behind locked doors for two weeks, we brought her home. In a few days she was drinking again. We then put her into treatment at Washington's Suburban Hospital, but she promptly broke out, went to a nearby restaurant, and collapsed from drinking.
    Realizing that Marian and Colleen were coming to our home for Christmas, she made a supreme effort to stop drinking and did so for their arrival and for the next several days. In past Christmases, we had arranged for Terry to have the guest bedroom at our home because of her two little children. This time, because our daughter Mary and her husband were coming home from UN service in Ecuador with their first baby, Caroline, we invited them to stay at our home and arranged a suite for Terry, Marian, and Colleen at the nearby Normandy Inn. This was a pleasant little hotel we had used frequently over the years. Eleanor and I had lived there for eight months in 1983 while our Connecticut Avenue condominium apartment was being rebuilt after a fire.
   I was very angry that my parents told me I needed to leave the house and stay in a HOTEL with my children. Ver jealous too of Mary--her new baby, the help she had, the money. And felt pain about what my children didn't get when babies. Felt ashamed to be dependent on parents--home at age 42, with no husband and children that no longer lived with me. Drank over it--turned to rag-e-threatened that if I had a gun I'd kill Mary, her baby, her husband, and my mother. Police called and took me to George Washington University Hospital Emergency Room. I woke up in 4 point restraints, where I lay all night. Next morning transported again to St. Elizabeth's--allowed out for Christmas Day--started drinking immediately again at Sage's.
   Sage, a friend of Terry's, was a recovering alcoholic. She persuaded us that knowing all the tricks of alcoholics from her own experience with the disease, she could "stay on top" of any move by Terry to drink. She stopped with Terry at our home and picked up Marian and Colleen with the understanding that the four of them would spend a couple of hours together Christmas afternoon and then return the little girls to our home for the traditional Christmas dinner while Terry had dinner at Sage's home and stayed there indefinitely if she could remain sober. Instead, when Sage took the girls and Terry to a family-style AA noon meeting in Georgetown to fortify the commitment to sobriety, Terry slipped out of the meeting to a nearby bar and filled up with vodka. Sage picked her up, brought Marian and Colleen back to our home, and returned the intoxicated Terry to St. Elizabeth's--a sad twist for all of us on Christmas Day 1991. Terry remained committed at St. Elizabeth's until her girls had returned to Madison and Mary and her family had returned to Ecuador.
    Reading The Washington Post early in January 1992 with Terry's committal to St. Elizabeth's on my mind, I came across an item indicating that a branch of the National Institute of Health that dealt with alcoholism and other addictions was willing to accept a few patients for a new experimental research program in alcoholism recovery. This news caught my attention for two reasons: I had the highest regard for the vast medical resources of NIH, with which I had become quite familiar during my long years in the U.S. Senate, and the program was free--an advantage that appealed to me after years of expenditures on Terry's earlier treatments and troubles.
    The NIH effort combined the recovery principles of Alcoholics Anonymous with research into the impact of alcoholism on the physical organs of the body. It was an excellent program, which Terry found especially pleasant in part because she had a comfortable private room, good food, and a reading and television room--in sharp contrast to the Spartan furnishings of St. Elizabeth's. In a sense, NIH was a haven for her, and she seemed to do well there during the six weeks of treatment and instruction. Eleanor and I also benefited from the family-related instruction on alcoholism as an addictive disease. But as I have noted earlier, within the first hours following her completion of the program, Terry was intoxicated and passed out in a bar. I was never closer to total despair. Terry's report on all of this and beyond:

From St. Elizabeth's transported to NIH Jan.-Feb.--drank day I left. March, committed to Georgetown University Psych Ward --April-May--Relapsed in Madison bar taken away--evicted from apt.--got drunk--spent night with 3 white men and one black made a Point of telling them all who my dad was so they wouldn't think I was just a drunk and a loser.  Terrible withdrawal began-vomiting, hallucinations, diarrhea, severe stomach pain. Began stealing all the time--all my money stolen. Charles verbally and sexually abusive. Police said be was dangerous. Called police on him--then I bad no one. Ann [her oldest sister] came out, but I was in detox.

    When Ann telephoned to tell me that she felt Terry was on the edge of disaster--probably death unless we could find some method of "reaching her"--I called my friend and former Senate colleague, Harold Hughes. Directing a recovery program especially for women in Iowa, Harold was himself a celebrated longtime recovering alcoholic. He had come to the conclusion that alcoholism hits women with special force and that recovery is more complicated and uncertain for women. Generously, he opened the door of his program to Terry. I sent her an airline ticket to Des Moines and made arrangements with Harold to have her met at the airport. Terry started drinking on the airplane en route and never gave the program a chance. She continued drinking even while supposedly in treatment. After telephoning her friend Nikki Abourezk in Vermillion, South Dakota, she went from Des Moines to live with this former college roommate.
    While there, she served as a housekeeper for Nikki and cared for her children. Again the drinking started, and Nikki asked her to leave and assisted her admission to the Keystone Treatment Center at nearby Canton, South Dakota. When her drinking continued, she went to Sioux Falls, stopped briefly to see my sister Mildred at her home, and then, after spending a night at the detox center in Sioux Falls, checked into a motel for several days. She then called me and asked if I would arrange an airline ticket for her to fly from Sioux Falls back to Madison. I agreed to do s o and called her cousin David Briles, who lived in Madison, to meet her at the airport. David called me later in the day to report with some alarm that Terry had not arrived as scheduled. Terry's journal tells why.

Don't remember where I was flying to, but was taken off the plane in Twin Cities, ambulanced to Hennepin County Detox--nightmare--went to Hazelden from there--started stealing, then drinking--then to detox center in Hastings, Minnesota. Scotty [another cousin] picked me up, got drunk at his home nearby, had to leave on bus to Madison, got drunk, couldn't stay at Sharon's. My wallet stolen that night. Tried to sleep outside at Ray's old apt. Neighbors called. Woke up in detox. Began series of staying with AA people.  Ran out of places to go, no insurance, no halfway house, no money. Went to D. C.-stayed sober one month.

While at our home in Washington that summer, Terry seemed to rebound quickly from the terrible previous weeks. Writing in her journal on August 29, 1992, she noted:  Five days of sobriety now. It feels so wonderful to pray again, to take care of my body, truly enjoying my family.... I went to my first Redskins game tonight. I really enjoyed it.... After the game Dad played hymns on the piano and I sang as be played. I recognized it as the intimate moment it was. He bas changed, and perhaps I have too, I don't feel so self-conscious around him. He knows where I've been so there's no use pretending I'm brilliant, ambitious, or very together. Just stay sober, unselfish, pray, and be grateful for the gifts of life I have been given and allowed to have despite alcoholism's best efforts to destroy them.
   I recall this scene vividly. It was a warm, relaxed sharing of memories and music that stirred both of us. Terry had a soft, wistful smile that I can still see. Then one night, she drove over to Washington's 14th Street in search of a marijuana dealer. Three men jumped her, took her money, and left her with a battered body. When they seized her billfold, she successfully pled with them to let her keep the pictures of her children. She recalls sitting in a bathtub later that night, hurting from head to toe and weeping. She began to drink again and lost control, and again we had to have her committed to St. Elizabeth's. She hated these commitments to St. Elizabeth's, Washington's well-known hospital for the mentally impaired, but it offered the security of a locked ward for those bent on self-destruction. It kept her from hurting herself or others--and it kept her alive. Terry then flew back to Madison at the invitation of a friend, Mitch Vesaas, to stay at his family home. Marian and Colleen came to see her once during this period. When Ray returned to pick up the girls, he found Terry in a drunken stupor.
    About this time, one of Terry's friends told her of a new treatment center for female addicts that was just opening in a secluded area at the edge of Madison, named Venebue. I went to see it with Terry, and we were both impressed with its serenity and uncluttered space. Only seven or eight young women were there in treatment. Terry entered Venebue in late November 1992 and remained through most of December.
    After a month, she wrote to Eleanor and me asking if when she was released in another month or two we would help her financially to resume a more normal life. "I do need to know if you will support me until I am able to be self-sufficient? I will need assistance for a place to live, utilities turned on and for moving my things from storage. I also need a bed and dresser which I intend to try and find secondhand. My hope is to find a house I can rent."  We agreed to all of this.
    Now as I write these repeated accounts of raised hopes and crushing disappointments, I wonder why Terry and Eleanor and I did not long ago say, "Enough is enough. This isn't going to work." But somehow each time Terry got up her hopes and her strength, our hopes rose with hers and we tried again. In retrospect, we probably should have said: "We'll finance this thirty-, or sixty-, or ninety-day treatment program, but only on the condition that you go directly from treatment into a halfway house for at least a year. During that halfway experience you must get a part-time job for a few weeks and then a full-time job." That course was followed in the Milwaukee effort of 1990, but it should have been the standard for Terry. She was too confirmed an alcoholic to respond satisfactorily to one of the regular twenty-one or twenty-eight-day treatment programs. In her case, as I suspect with many alcoholics, a month-long treatment is comparable to a beginning swimmer putting a toe in the water. I can't really explain satisfactorily to myself why we repeatedly went down that road to defeat. The Venebue program was no exception.
    The problem with short-term sobriety for Terry was that she couldn't bear her life's pain without alcohol. Almost from the moment she moved into sobriety, she was beset by anguish--especially over the breakup of her family and the loss of her children. Sobriety brought pangs of guilt and regret over her failures, blown opportunities, and conduct painfully at variance with her moral standards. Sobriety was terrible for Terry. Her unusually perceptive and devoted friend Susan Robillard observed that for Terry "moments of lucidity created too much pain."
    Having written so much of Terry's defeats and disappointments, I also see another Terry: the wit, the loving friend, the fascinating companion, the fighter who would never surrender, who kept coming back. Some years ago, I watched two ill matched boxers in the ring--one with a reach four or five inches beyond his opponent's, plus a wicked one-two combination. The smaller fighter had only his pluck and his tenacity. He would take a hard left jab to the chin from the bigger man and before he could fully rebound from that he was on the receiving end of a jarring right-hand smash. I could not avoid attaching that image of the battered fighter to Terry. She would reel from the ravages of alcohol abuse, but when she became sober she was hit by the even more painful realities of sobriety.
    Two of her many friends in Madison were Audrey and George Henger. Audrey wrote after Terry's death:  I have wept over the loss of Terry--a gentle person who wanted me to believe in her--that's all. Sometimes I forgot and tried to help her. She would then disappear like a soft breeze, sometimes like mercury. She liked me to tell her the Ballad of Jack Armstrong: "I will lay me down to bleed for a while and I'll up and fight again." I believe she is now in a better place--a place of peace where she will no longer have to fight.
    Another Madison resident who knew Terry even more intimately was her devoted therapist of many years, Jill Leventhal. After Terry's death, Jill wrote us: I never knew anyone who tried as hard as Terry did to get well. She never gave up her faith, not even in her most desperate times. I know that her death did not signal her desire to die. She wanted to live, she wanted to stay sober, she wanted to have something in her life that was an anchor that she could hold on to. She just wasn't able to do it.   Two weeks before she died, Terry called me to ask if I could see her again. . . . This was so typical of Terry, to be once again trying to unravel the mystery that continued to lead her back to alcohol. . . . I had always found Terry to be a deeply spiritual person and I had hoped she could draw on this in her search for sobriety.... Terry never lied to me about her drinking; she was unwaveringly honest about all her shortcomings....  She was very special, and I, like you, wished that I could save her. However, along with her tremendous desire to get well, she carried with her an overwhelming melancholy that had been with her for as long as she could remember; she was one of the saddest people I have ever met. She struggled with conflicting and intense feelings of sorrow, loss, rage, and emptiness. When she looked inward, she was faced with an abyss of loneliness, despite the qualities that others so loved about her. This was not because people did not care deeply for her, but because she could not feel their love when she was alone.... I have thought that you, too, knew that her struggles were deeper than even the intrepid battle she faced with alcoholism.
    I believe that the key to Terry's life and death may be found around these central points: she was an alcoholic who longed desperately to be free of her alcoholism, but that disease combined with related emotional torment had so injured her mind and spirit that she was unable to live at peace without alcohol or some other drug. The one condition that was even more unbearable to Terry than intoxication was the emotional agony that seized her when she was sober. A supreme and relentless participation in all aspects of the AA program might have overcome this dilemma, but for whatever reason, Terry eventually lacked either the will or the strength required for such a commitment.
    I believe that Terry was born with genes that made her vulnerable to drug addiction. I also believe that whatever the cause--marijuana, LSD, or alcohol, or her family and social environment, or her genes, or all of these--she was an emotionally distressed and depressed individual. What so baffled her friends and family was that her internal sadness and conflicts were usually hidden behind an endearing, delightful personality.
    One longtime friend, Tierney, trying to describe her feelings about Terry, said to me: "I just can't tell you how good she was, how smart, how funny, how honest she was." That is a succinct portrait of Terry that has been expressed to me by countless friends over the years.
    Terry proved that a troubled adolescent can also have a charming personality. We loved her and she loved us, but she could not love herself and wondered how anyone could love her. She seemed to be saying: I can't accept my life and the way I have lived. I can't accept my tormented view of myself. How can anyone else accept me? The best answer to all of this was to have a drink or two-or ten.
    In her darkest hours she would sometimes say in effect and in various ways: My father neglected me, my sisters resented me, my mother shamed me, the father of my children deserted me, I've lost my children, I have no home, I'm a drunk. How can I love any of this? How can anyone love this? It's time for a drink.  Some people feel great when they are sober. I feel rotten. Let's have another drink. I was once a lovable little girl and people smashed me down. If they didn't love me then, bow can they love the mess I've now become? I can't live with this. I need a drink right now.  Drinking may cause a problem, but it can't be as bad as the agony of sobriety. It may kill me to drink, and I don't want to die, but if I don't drink, life is unbearable. Let me have one more drink so that I can at least get out of bell for today.
   Terry came to stay with us again on September 28, 1993. She did so at our urging, because, as Eleanor put it, "if she's going to die, I want her to be with us when she dies." Neither Eleanor nor I really expected Terry to die. I always saw her as a battler who would never surrender. But I shared Eleanor's feeling that Terry's relapse pattern was both frightening and life-threatening. Following her arrival, Terry wrote on September 30, "I want to be right where I am and not go anywhere--make myself safe."
    A few days later she was drinking again. Begging me not to put her back into St. Elizabeth's, she agreed to go to the highly regarded Seventh-Day Adventist hospital in Takoma Park, Maryland. She was there for several weeks. As almost always in these treatment centers, Terry "turned around" dramatically. Within a few days she became the darling of her ward. Each time I went to visit with her, she seemed so warm and cheerful that I would again conclude that this was it. Terry was going to be okay this time. I'd get my wonderful daughter back into my life. She was going to be sober and happy again. This time things would be different. Terry was going to get well.
    On October 30, 1993, Eleanor and I were to observe our fiftieth wedding anniversary at Washington's Embassy Row Hotel with a party sponsored by our children. Terry desperately wanted to be in attendance, and the entire family wanted her to be there. I talked to her doctor at Takoma Park Hospital, Dr. Fred Risser, a longtime family friend, and he agreed to release her for a few hours with the understanding that someone be designated as her chaperon and make sure she got back to the hospital by midnight.
    I think this was one of the happiest nights of Terry's life. She loved that party-the celebration of her parents, the toasts recalling our fifty years together, the photo sessions with the family. She glowed and joked and reveled from beginning to end. I recall so many of her happy expressions, embraces, warm exchanges, laughs, and tears of that magical night. One of her closest longtime friends, Dawn Newsome, was her designated chaperon, and she delivered Terry to the hospital at the stroke of midnight. She reported later that if there is such an experience as pure joy, Terry found it for that long, happy night.
    One poignant moment remains in my mind. When Terry came into the beautifully decorated hotel reception area, wearing a new dress purchased by Dawn, I saw her pause at the door, look tentatively around the room, and then, with a brave smile, walk toward Eleanor and me. I was simply overwhelmed with a feeling of tenderness. My precious, fragile, terribly sick daughter, on leave from the hospital, dressed in the prettiest gown she could find, was desperately wanting to show her love for her mother and dad. I treasure a camera shot of her holding my hand and looking around the room for the rest of the family-a mixture of anticipation, anxiety, and pleasure on her face. I'd seen that look countless times during Terry's life.  She made it a point to talk to nearly every person in the room that evening, and dozens of them later told me of the joy that shone in her eyes and echoed in her conversation.
    Two weeks later, she was writing:  I need to write this as tears well up in my eyes. Because truthfully I had no memory of what it feels like to quit drinking once I've started. Now I will list how it feels after 3 drinks to have to stop.
1. Depression, 2. Anxiety' 3. Some fear, and 4. Agitation.  My body and mind do not feel relaxed, even though a non-alcoholic's
mind and body would be relaxed after 3 drinks. My body is telling my mind, just one more, a really strong one would do it--coat the nerves and they'd stay coated and numbed. With all my being I would like to have been like the man who could drink a shot of whiskey every morning like a cup of coffee and leave it be. But what happens is that shot gives me a feeling of wholeness, and when it starts to go away there is artificial emptiness just as there was artificial wholeness. . . . I could weep and weep that the lie is still alive. How could I want to keep company with the same agent that has snatched from my grasp all that I have loved. God forgive me. Teresa, forgive Teresa. [November 13, 1993]
   Back at Takoma Park Hospital a few days later, she writes:  I had a positive experience here before, and I will again. Billie, Jane, Jasmine, Fred Risser, and Judie. Tomorrow the depression will have lifted and I will sleep well tonight. Tell Fred about difficulty reading, concentrating, and finishing projects. I'm much more comfortable with him. ... sobriety is my only goal now. Tomorrow I'll get to see the place in Rockville [a "habilitation and recovery center recommended by Dr. Risser] and I'll stay here until I can get in. [November 17, 1993]   Recovery from alcoholism represents a period of remarkable change. It's a bit like a second adolescence. The recovering person's body is something of a biochemical volcano, erupting from time to time in strange ways, shaping and influencing responses to ordinary events. [December 2, 1993]
   Alcoholism--that was the hidden monster--alcoholism, the unconscious disease.
   I feel peaceful again-most peace since I've been here.... Nothing ends life--death not linear. Calling Madison my hometown [at the AA meeting] and then saying, "When there's a blackout I was no safer than at 2 years old, out alone and people did hurt me." [December 5, 1993]
    The treatment at Takoma Park followed by additional care at Rockville seemed to be helpful for Terry, and she, Eleanor, and I went to National Airport to greet Marian and Colleen on December 18. Christmas was a week away, and it was a happy, festive time. But Terry took time to note in her journal: "When the disease reaches the stage where it severely impairs an individual's ability to control consumption, then 'moral' choices as to when to drink, or to cut down or control consumption, will become meaningless."
    After enjoying two weeks with Marian and Colleen at our home over Christmas, Terry remained with us through January and February 1994. These months, however, were marked by more relapses and brief recoveries. Late at night, January 30, 1994, after a day of drinking, she called me into her bedroom and begged me to get her another drink. I refused. She then asked if she could borrow my car to visit a bar. I explained to her that it was after midnight and the bars were closed. I also pointed out that an ice storm that day had left the hill on which we live coated with ice. There is a drop-off at the bottom of the hill, and I feared that even a sober person, let alone one as intoxicated as Terry, would very likely encounter a disaster in trying to drive a car down that icy hill. A half hour later I thought I heard a noise in front of our house. It was Terry, sitting in the driver's seat of a new car I had just purchased for Eleanor with the windshield wipers swishing futilely over the ice-covered windshield.
    I went out to remove Terry from the car. She clung to the steering wheel, determined to drive down the hill. I could not reason with her and I could not dislodge her from the car. Her desperate determination frightened me. I'm a physically strong person; I was sixty pounds heavier than Terry; she was drunk and I was sober; yet I could not get her out of the car. It was a dramatic demonstration to me of the overwhelming power of an alcoholic's craving for alcohol. She was not concerned with the danger of a crash that might have claimed her life or someone else's. She was totally dedicated to one objective: more liquor for her tormented body.
    Only the fear of a disastrous crash finally gave me the strength to pry her hands from the steering wheel and drag her from the car. I did not know that Terry had released the brake and moved the gearshift from park into drive. As she cleared the car, it lurched forward down the hill without a driver. Hitting the bare ice, it spun to the side and smashed with some force into the side of a neighboring house. Terry had warned me forcefully an hour earlier that she could not go through the night without more liquor. I thought I was tight in ignoring this warning. I was wrong.
    The point of this story, however, is the incredible power of alcoholism to seize the victim's whole being. "Dad, my whole body is screaming in agony for alcohol. Please, please, please!" And then in a moment of forced gentleness, still pleading: "Dad, why don't you sit on the edge of the bed and just quietly have a drink with me." Possibly I should have done that on that particular icebound night at an hour when Terry was crying out for mercy from the depths of her soul.
    Achieving a period of sobriety again for a few weeks after this incident, Terry asked if I would return to Madison with her and help her get settled in an apartment. She wanted me to commit ten days to this trip. I agreed to go back with her, but after finding a comfortable apartment for her on Farley Street and moving her furniture there from storage, I returned to Washington after three or four days. Needless to say, I wish now that I had canceled my appointments in Washington and stayed with her longer in a more relaxed fashion.
    We of course did a number of things, as did Terry, for which I am grateful. All the treatment programs, detox periods, and hospitalizations were costly and also discouraging when they were owed by relapses. But those were times that gave her body and mind an opportunity to heal. Without those breaks in her drinking pattern, she would doubtless have died many years ago. Adding up all the time devoted to these periodic treatment sessions means that in addition to the eight years of sobriety in the 1980s, Terry had additional years of cumulative sobriety when her vital organs were healing from the damage of alcoholism. I'm glad that we tried repeatedly to open the door to sobriety for her and that she repeatedly got at least partway down the path of recovery.
    I rejoice too when I recall the trips, the movies, the restaurant meals, the kidding, the fun, and the thousand quips we had together, a continuing reservoir of good memories. But there weren't many quips or laughs in 1994. Within a few weeks after Terry and I had found the Farley Street apartment in early March, she resumed drinking again. Her medical and police records on file at the Tellurian Detox Center and the Madison Police Department tell that story in all its pathos and deepening tragedy:

April 14, 1994-Time 1: 12 p.m.-[Terry living at 513 Farley] Subject was found passed out sitting up against a fence. She was very intoxicated, she had a hard time keeping her balance. Her speech was slurred, she smelled very strong of intoxicants. She informed me that if she was taken home she would go back to a liquor store and buy some more alcohol. Said she had been drinking vanilla extract.  Sgt. Bruce Beckman

April 14, 1994
- Time 1312-Client brought to detox by Shorewood Police Department and was placed on Protective Custody-
April 15, 1994- 10 a.m.-Discharged from detox
April 16, 1994- 10:07 a.m.-Admitted to detox. McGovern was on a city bus very disoriented. Fire Rescue responded and determined there was no health problem or risk. McGovern was intoxicated. She had difficulty answering questions and could not stand by herself. We conveyed her to detox for treatment. She was incapacitated by alcohol. On April 16-18 detox, Terry said she had been sober for 6 months prior to the April 14 detox. Said she was to start job April 18 and to see her children that weekend. April 18, 1994-1:25 p.m. Discharged.
May 6, 1994- 3:25 p.m.-Admitted to detox. Transported intoxicated from St. Mary's Hospital. Passed out walking home from liquor store and taken to St. Mary's. "I hurt all over." Talked of her coming family vacation at Outer Banks. Prognosis for sobriety poor based on frequent admits to detox: 4-14-94, 4-16, 4-24, and 5-6. Discharged May 8, 2 p.m.
May 17, 1994- 3:30 p.m.-Admitted detox. Passed out on Capitol Lawn. Taken to University of Wisconsin Hospital and then to detox. Discharged 5-23, 9 a.m.
July 5, 1994- 1:25 a.m. Arrested with man for disorderly conduct while detox. Found sitting with Joseph Skully behind closed shopping mail and restaurant. Admitted to detox. Says first time she drank since family vacation at Outer Bank June 17-July 1. Discharged July 5 at 1:25 p.m.
July 16, 1994- Admitted detox. Discharged July 19, 6:45 p.m.
July 25, 1994- Admitted detox 1:45 a.m. Taken to St. Mary's emergency room 8, then to detox. Discharged July 26 at 10:55 a.m.
July 27, 1994- Admitted detox 9:50 p.m. Discharged Aug. 1, 1994, at 9:55 a.m.
Aug. 4, 1994- Admitted detox 1:45 a.m. Arrested for taking 6-pack of beer-intoxicated Discharged 8-8 at 10:20 a.m.
Aug. 15, 1994- Admitted to detox. Found passed out in storage room of Party Port Liquor Store
    Regrettably, Eleanor and I were at the University of Innsbruck in Austria, where I was lecturing from July 1 until August 10. We were not in telephone contact with Terry during this period. But upon our return to Washington, I spoke with Terry's counselor at Tellurian, Gerry Kluever. She advised me that Terry was not doing well and might have to be committed. I confirmed my desire that she be involuntarily placed in long-term care if she continued to relapse. It is not a simple matter to have a person committed to hospital care against the patient's wishes. The Tellurian staff was slowed by the need to prepare a legal case demonstrating that Terry was a threat to herself. They also later told me that their personal affection for Terry made it difficult for them to take legal action against her when she was pleading with them not to do so. The staff was probably in error in postponing this action, considering Terry's record of continued, chronic relapse.
    I'm going to let the records of the Tellurian Center and the Madison Police Department tell the story of Terry's painful progression toward death.
Aug. 17, 1994- Discharged 1:50 p.m.
Aug. 19, 1994- Admitted detox 3:17 a.m. Terry found passed out in restaurant with head injury. Taken to U. Wis. Hosp. And then to detox. Back of head-scalp injury
Aug. 19, 1994- 3:17 a.m. Brought-by police. Passed out. Head injury from unknown cause. Unable to walk-very garbled speech. Danger to Self. U.W. Hospital. Requested transport due to head injury and alcohol incapacitation. Depressed. Passed out in a restaurant with head injury. Blood alcohol level .44. Discharged Aug. 23, 1994, at 9:37 a.m. 70 mg. Librium given in her first day of admission (Aug. 19-none needed after that). Terry had Antabuse with her--apparently released to go with Art Lahey.
Aug. 20, 1994-  Pain neck from head wound in back of scalp. Could take several days for blood to reabsorb.
Aug. 21, 1994-  Terry wants to get back on Antabuse. Started to cry when she told counselor about the terrible cravings she has to drink.
Aug. 22, 1994-  Terry plans to live with Art Lahey at Horicon, Wis. Old friends--nothing sexual.
Aug. 29, 1994- Brought by police from emergency room at St. Mary's Hospital to detox with blood alcohol level of .36 Danger to Self. Taken to St. Mary's for CAT scan after friends thought she fell in her hotel room. Terry drank at Art Lahey's after going there Aug. 23 from detox.
Aug. 31, 1994- She cried when told she was drunk in front of Art's daughter. Art took her to Motel 6.
Sept. 1, 1994- Discharged from detox, 1:37 p.m. Noted at 1 0 A.M. on this date that Terry shows minimal motivation toward sobriety evidenced by her discharge plan for herself and refusal of voluntary stay to assist a long-term recovery. Terry was told she could return to detox voluntarily if she realizes she may drink and wants to return sober.
Sept. 2, 1994- 7:37 a.m. Teresa somehow ended up in Madison General Hospital Emergency Room. She was so loaded with alcohol she couldn't do anything without help. Placed in police car and taken to detox. Passed out in lobby of a hotel and transported to hospital for evaluation. Blood alcohol level .432. Hit head in falling at Holiday Inn. Danger to Self
Sept. 29, 1994- Gerry Kluever, her counselor, says Terry remains sober. Had enjoyable weekend with her children. Stress in her living situation. Will start job this week on trial basis. Terry was told if unable to cope she could return to detox voluntarily. Terry expressed concern that she might be "biting off more than I can chew." Told she needs to stay within her own comfort zone. Terry says she may go to S.D. this week for presentation her father may receive (S.D. Hall of Fame). Terry still in Horicon Said she is seeing her daughters regularly and enjoying this. Has some anxiety however, as they will spend weekend with her and she has always had to drink to deal with this.
Oct. 10, 1994- Arrives per friend at detox, unable to walk.  1. Strong odor of alcohol, 2. Mumbling, slurred speech, 3. Inability to walk, 4. Disoriented-place and time, 5. Reddened eyes, unable to focus, and 6. Unable to care for self
Oct. 11, 1994- Resting in room. Afraid because she is homeless and has resumed drinking concerned where she will live-- "Maybe I can stay at some AA friends." "if they don't commit me, I want to go to Hope Haven [halfway house], Teresa expresses extreme remorse and depression over repeated relapses.  She was released to Hope Haven Halfway House on October 24, 1995.

Nov. 13, 1994,
Time 2359- Hodge reported a female/white passed out at the bar. On arrival I contacted McGovern, who was passed out. . . . I was unable to rouse McGovern. Police officer Papp and I escorted McGovern out. McGovern was very unsteady on her feet.... I placed McGovern in police car and conveyed her to detox. Bar personnel advised that she walked into the bar, ordered a drink, and then passed out. McGovern told me that she was taking Prozac. Inappropriately dressed for cold weather. Police officer B.A.

Nov. 14, 1994
- Time 0245-Admitted. A 45-year-old white female was brought to detox via Madison Police Department-being reported as missing from Hope Haven. Client was passed out at Red Shed bar-unable to walk-slurred speech-told R.N. at detox entrance unit she had started to drink in front of daughters. Client has tremors and receives Librium 25 mg.
November 15, 1994- This writer shared her opinion with client that she has become a drunk who passes out in bars and becomes incontinent of urine. In this written opinion, client needs to put on hold her "spiritual life" through books and deal with the basic issue that she is an alcoholic. Client also shared that when she spent time with her daughter on Saturday she had wine with lunch and told her it was grape juice. This writer responded that children know more than we think they do and chances are daughter knew she was drinking. It is in this writer's opinion that client needs to work on self and spend as little time with children as possible for now.... Client is also unable to make safe choices in the community as she is presently homeless. . . . Client is unable to remain safe from alcohol when in an unstructured environment. Client will be reevaluated on Nov. 17, 1994, for possible discharge.

Nov. 17, 1994
, Time 1435- Officer Greg Martin and I were dispatched to 20th Century Books, 108 King St., reference a woman passed out and unresponsive. Upon arrival with Fire Rescue unit we contacted Teresa J. McGovern. The complainant, James H. Luttrell, stated that he found McGovern seated in a chair in his office.  McGovern was asleep and Luttrell could not wake her up so he called Fire Rescue. I noticed that McGovern's breath smelled heavily of alcohol, her speech was slurred, and she did not stand without assistance and had to be helped down the stairs. When I told McGovern she was going to detox, she tried to break away. She begged us not to return her to detox. Police Officer Chris Smith

Nov. 18, 1994
, Time 0900- Client appears depressed. Client has tremors, states, "I'm going to my parents' home in D.C."
Nov. 19, 1994- Time 1535. Client medically stable for discharge. Left unit per self.
Nov. 20, 1994- Friend [Art Lahey] that client was staying with brought client into detox.... Friend stated that client had been drinking for two days.... Client opens her eyes, very somnolent, moans, needs assistance of two aides, nauseated. Client incapable of meeting basic needs.
Nov. 22, 1994- Time 1630. Client is discharged to stay at home of AA member [Kate Morgan]. Client pleased, stating that she and female friend would attend a play at her daughter's school. Client asked that message be relayed to friend Art if he stopped by detox. Art is to bring client's turtle to Williamson St. Cooperative where client will meet him at 6:30 p.m.

Nov. 23, 1994
, Time 2030- Madison Fire Dept. responded to Wong's Restaurant to check on McGovern. McGovern had ordered dinner and had apparently been drinking heavily. Upon my responding I contacted paramedic Scott Hermansen from Rescue #4. Hermansen stated that McGovern has a lengthy history of this behavior. McGovern was attempting to sleep in the booth she was sitting at when I arrived. Hermansen checked over McGovern and requested she be taken to detox. I then transported McGovern to detox. Police Officer L. Wing

Nov. 25, 1994
- Client talked about a person named Kate [Morgan] who client says has 7 years of sobriety and has agreed to be client's sponsor. Client also says she plans to move into own apartment next week. Client was crying during most of the session. As client thinks about effects of alcohol on her life she fears that recovery may not be achieved.
Nov. 26, 1994. Client discussed hopes and fears of having a new apartment to move into near her children, of having a new sponsor, and another chance to develop a sober lifestyle. Client expressed fear of having another failure at attempting sobriety. States: "I don't think I could stand it again, another failure." Client's frequent admissions to detox presents a questionable ability to care for herself and her basic needs in the community at this time.
Nov. 28, 1994. Client talked at length about her decision to try therapy with counselor she had experience with (outpatient in Monona) [Jill Leventhal]. Client states she was always looking for something different "but realizes there's nothing she hasn't tried" before. Client appears more open than in the past to look at changes needed within her rather than externally. She expressed awareness of fears that impeded her in attaining sobriety, and described support available to her (including Community Intervention Team and AA people helping her during upcoming relocation to new apartment).
Nov. 29, 1994. Review of Client's aftercare plan. Besides CIT [Community Intervention Team] and AA support and outpatient therapy, client will be living temporarily with female recovering friend and sponsor [Kate Morgan] and moving into new apartment in 3 days.
Nov. 29, 1994- Time 0957 Client left per self.

Dec. 1, 1994-
Time 1610. Police Officer Baker and I were dispatched to the above address, University of Wisconsin Hospital Emergency Room ref: a transport to detox. Upon arrival we contacted the Emergency Room staff who informed us that McGovern was very intoxicated and had a high blood alcohol level. McGovern who was obviously incapacitated by alcohol was placed under Protective Custody. McGovern was transported to detox where she was admitted. Police Officer Jim Strassman

Dec. 1, 1994,
Time 2042. Client taken to U.W. Hospital via Madison Police Dept. after being reported passed out on a city bus. BAL=.420 A danger to self. Bloodshot eyes.
Dec. 2, 1994- Time 0945. Client keeps asking to get out so she can try and regain her apartment. Client further reports that she stole beer from the workman at the apartment while the floor was being done....This writer recommends that client be maintained on unit on Protective Custody because client presents a questionable ability to care for basic needs and safety.
Dec. 2, 1994- Time 1330. Client requests use of phone on social side to call her landlord to get information regarding her down payment on apartment. Client is unable to use phone on Medical side as another client is screaming. Client is appropriate in request. After using phone on social side client waited by door to administrative side of building. Client proceeded to leave detox as housekeeper entered door. Client ran out administrative door. Client has no shoes, no coat, and no money: Madison Police Dept. notified of incident and that client remains on Protective Custody in detox.

Dec. 2, 1994
, Time 2001. Officer Fields and I responded to Meritor Park Hospital Emergency Room for a Police Car Conveyance. McGovern had a blood alcohol level of.442. Emergency Room staff stated McGovern had been involved in some kind of disturbance involving another female on Gorham St. where she was ultimately conveyed by Fire Rescue to Meritor Park Hospital due to extreme intoxication.... We conveyed McGovern to detox.

Dec. 2, 1994
, Time 2035. Client admitted to detox. BAL.440. Unable to care for self. Needed assistance walking. I believe this person is incapacitated
Dec. 3, 1994- Time 1410. Client states she called a cab and went to the downtown area. While downtown client states she went to the bank and got $, then purchased some footwear. After this client states she was concerned about an apt. she is currently trying to rent; so she went to the location. After visiting the apt. in the Williamson St. neighborhood she went to the liquor store, bought alcohol, became intoxicated. Client states to writer that she does not regret what she did due to her concern over not getting to an appointment to talk with landlord. Is sorry about how she went about it. . . . I recommend that this client be maintained at detox unit on Protective Custody due to the need to further monitor and evaluate client after excessive intake of alcohol. Client currently requires medical supervision due to past incidents of major withdrawal symptoms including tremors and diaphoresis. Client has been to unit many times in the past and does not maintain adherence to recommendations or advice given in past. Client currently suffers from active alcohol dependency.
Dec. 4, 1994- Time 1315. Client wanted to know if she would be allowed to go to a therapy session on Wed. Dec. 7 at 1330 located at the Verona Family Practice Clinic to see therapist Jill Leventhal. Client states the session was recommended by Gerry Kluever, client's primary counselor on unit. . . . I recommend that client be maintained at detox unit on Protective Custody due to her excessive consumption of alcohol. Client is currently actively alcohol dependent.
Dec. 5, 1994- Time 0740. This person's denial as to the seriousness and consequences of her alcohol use is intense. She appears to believe that she is in complete control and is making logical choices. I recommend that this client be treated confrontationally with facts of behaviors and consequences. Informed client that she will be maintained on Protective Custody due to her chronic habitual use of alcohol evidencing an inability to care for her health, safety, and basic needs. Multiple repeated detox admissions.
Dec. 6, 1994- Time 1000. Client reports multiple concerns re: housing, relationships, etc. Client was directed as to plans to prevent further life damage working with a sponsor to: 1. Hook up with psychotherapist to work with father of her children on reasonable visiting plan,  2. Look into group of women with children who are affected by alcoholism. (Deal with guilt, relationship, etc.), 3. Contacting women in neighborhood to be supportive of each other, and  4. As soon as possible service work with Riverview club near new pending apartment. Progression of client's alcoholism discussed. Client admits if present plans fail feels long-term treatment is appropriate. States would not do in Madison but would seek long-term care with father's support. Guilt over inability to deal with children when sober. Made appointment and plans for ride to therapist Jill Leventhal tomorrow. Has sponsor and is working with her. Unable to care for self as evidenced by repeated admits, unpredictable behavior, deteriorating health.
Dec. 7, 1994- Time 0800. Reviewed and signed discharge plan. States has problem getting appt. landlord-Reconsidered and will probably be ready this weekend-plus limited time with children. . . . Also has decided to go along with ex-mate relative to limited visits with children as "I don't have the energy I need to care for them." Reported ambivalence about support system she has set up for self. If this doesn't work, I will go to long-term treatment. Discharge with Community Intervention Team to appt. with therapist.
Dec. 7, 1994- Time 0850. Client medically stable. Discharged from unit with Community Intervention Team member.

Dec. 7, 1994-
Time 2030. Officer Armagost and I responded with Fire Rescue ref. a woman by the Williamson St. Co-op, 1202 Williamson St. The woman McGovern was found in the co-op with towels around her feet as she had been walking in the snow and cold with only tennis shoes and wet socks. She had an odor of intoxicants on her breath, slurred speech, and could not stand without assistance. She could not speak coherently and mumbled about a sponsor. McGovern was unable to care for herself and was incapacitated by alcohol and placed under protective custody. She was conveyed to detox after being seen by Fire Rescue. Police Officer Jerry Fouzei
Dec. 8, 1994- Time 1600. Reports ride to Community Intervention Team with CIT member. "Called father to co-sign for lease. Went to bank--took out $550--got nervous because I had so much cash and returned to CIT to ask that they hold it so would not be stolen." Client did have Antabuse though chose not to use it. Client states "from my memory" they kept the money for me--"but I guess that did not happen." Client reports obtained wine. Went to St. Vincent's, bought scarf and socks--they had no mittens. Had lunch with Marian at her school/glass of wine. Went to apt. to give $ to landlord but wasn't there. "I had hoped I had slipped the money under the door but called landlord to learn I had not." Went to Crystal Corner Bar-the last bar Steve [her recently deceased male friend] was in. Went back to apt. But locks had been changed--went to neighbors to get pen and write name and address for mailbox and taped to mailbox because expecting a letter--"as far as I remember, I only drank wine. . . . I remember falling and getting wet and being embarrassed hoping no one had seen me.... I went to the co-op to wash my face.... I don't remember anything after that until woke up here. . . ." Client informed commitment being pursued. . . . Client appears sad ... depressed ... denies suicide leanings ... refuses to sign Release of Information for counselor to contact parents. . . . Client reports knew commitment was coming and asked father today to check into treatment program for her. Client reassured when asked if would have to 3ust stay here" that every effort would be made to get treatment for her. Client told will be maintained under Protective Custody until medically stable and able to care for basic needs due to alcohol dependence.
Dec 9, 1994- Time 0840. Brief discussion of client's pending legal commitment, client reports being aware of it via her primary counselor [Gerry Klueverl. Client claims she would still like to arrange treatment on her own but expressed belief that it's pretty much out of her hands now. Client's attorney is Yolanda Lehner who is "hard to reach." Overall, client appears resigned to being committed to alcohol and other drug abuse treatment based on her statements and dejected manner. She described the theft of her $600 as "the last straw."
Dec. 10, 1994- Time 0800. Reports she has been experiencing mild panic-attack. States she is upset about having all her money stolen, but states that most of the anxiety she is feeling is related to a pending involuntary commitment. States she has called her father and they will be making calls to see where she can get long-term treatment that her medical assistance will cover. States, "I don't want to get stuck in this place for a long time that won't even count."
Dec. 11, 1994- Time 1145. States she wants to have her primary counselor know that she set up an appointment with her landlord for 0900 on Monday 12-12-94. States she is looking forward to keeping her doctor appointment for a medical evaluation to see if having taken Prozac is preventing her from maintaining sobriety. Client expresses anxiety reference to commitment process. Wants to know if she didn't drink now if there was any possibility she could avoid the commitment.
Dec. 12, 1994- Time 0800. Client appears confused this a.m., denies having any trouble with memory and states "I'm just depressed." Client was confused as to whether or not medicines had been given.
Dec. 12, 1994- Time 0900. Client and counselor discussed plan for discharge this A.M. Request discharge to take care of things: see landlord, pick up social security check to replace money "borrowed" from deposit, close bank account and library card due to stolen ID, and to check with police for purse. Client informed plan is to pursue commitment with papers to be filed Wednesday and schedule her court appearance Friday. Client very concerned about where will be served, i.e. in public or with children, etc. Client encouraged to return here after errands. Client states will not return today. States will stay with sponsor "Kate" tonight and if she needs someone to talk to today will go to Community Intervention Team. Client also makes point--does not want sponsor, family, or friend Art involved in commitment proceedings. Client denies suicidal thoughts-states she knows what to do if feels like drinking will call or stop at Community Intervention Team, call detox unit, or call therapist or sponsor.
Dec. 12, 1994- Time 0900. Client remains medically stable and is discharged to community per self.

There are no more Tellurian Detox Center records for Terry--only a report from the Madison Police Department the next day that her frozen body had been taken to the St. Mary's Hospital morgue.